Comments on: Thoracic Paravertebral Catheters in Cadavers http://www.raeducation.com/2009/03/thoracic-paravertebral-catheters-in-cadavers/ Regional Anesthesia Education...and Discussion Sat, 06 Mar 2010 17:52:08 -0500 http://wordpress.org/?v=2.9.2 hourly 1 By: Veerandra Koyyalamudi http://www.raeducation.com/2009/03/thoracic-paravertebral-catheters-in-cadavers/comment-page-1/#comment-36 Veerandra Koyyalamudi Thu, 17 Dec 2009 22:29:13 +0000 https://www.anest.ufl.edu/gator-rap/?p=349#comment-36 Again this brings up the point as to whether we should just move towards epidurals for the management of rib fracture and thoracotomy pain. There is no definitive end point and many a time I find myself not sure if the paravertebral catheter was in the right place. Again this brings up the point as to whether we should just move towards epidurals for the management of rib fracture and thoracotomy pain. There is no definitive end point and many a time I find myself not sure if the paravertebral catheter was in the right place.

]]> By: Steve L http://www.raeducation.com/2009/03/thoracic-paravertebral-catheters-in-cadavers/comment-page-1/#comment-35 Steve L Thu, 17 Dec 2009 18:07:03 +0000 https://www.anest.ufl.edu/gator-rap/?p=349#comment-35 I would be intersted to know more specifics. We have only the ultrasound spread noted by the original proceduralist to confirm needle position in the space. Before we conclude that all of these needles were in the right place, but only 55% of the catheters ended up in the right place, I would like to see some type of confirmation(i.e. U/S picture confirmed by a seperate ultrasonographer)Second, what kind of catheter were they using? Was it stiff? How much catheter did they thread into the space? So I would say cautionary, but not disheartening. I would be intersted to know more specifics. We have only the ultrasound spread noted by the original proceduralist to confirm needle position in the space. Before we conclude that all of these needles were in the right place, but only 55% of the catheters ended up in the right place, I would like to see some type of confirmation(i.e. U/S picture confirmed by a seperate ultrasonographer)Second, what kind of catheter were they using? Was it stiff? How much catheter did they thread into the space?
So I would say cautionary, but not disheartening.

]]> By: Myles Conroy http://www.raeducation.com/2009/03/thoracic-paravertebral-catheters-in-cadavers/comment-page-1/#comment-34 Myles Conroy Thu, 17 Dec 2009 04:04:56 +0000 https://www.anest.ufl.edu/gator-rap/?p=349#comment-34 I have tried this approach in anaesthetised patients on >10 occasions. In contrast to comments above, I have found the needle difficult to identify, let alone the tip, despite some experience with paravertebral imaging and inplane blocks in general. Needle localisation is best demonstrated by injections of saline as the needle is advanced. Expansion of the paravertebral space is visualised as the pleura is pushed deep above and below the level of insertion and correlates with success. The catheter still tends to be difficult to feed, so depositing it at the end of the needle seems to suffice. The last time I followed this approach I managed to deliver excellent analgesia for 12 unilateral fractured ribs that lasted for 1/52 before the block failed! I have tried this approach in anaesthetised patients on >10 occasions. In contrast to comments above, I have found the needle difficult to identify, let alone the tip, despite some experience with paravertebral imaging and inplane blocks in general.

Needle localisation is best demonstrated by injections of saline as the needle is advanced. Expansion of the paravertebral space is visualised as the pleura is pushed deep above and below the level of insertion and correlates with success. The catheter still tends to be difficult to feed, so depositing it at the end of the needle seems to suffice. The last time I followed this approach I managed to deliver excellent analgesia for 12 unilateral fractured ribs that lasted for 1/52 before the block failed!

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